P-P56 Successful endovascular embolisation of a recurrent gastroduodenal artery aneurysm in a patient presenting with acute on chronic pancreatitis

Background Pseudoaneurysms are recognised to be a serious complication of chronic pancreatitis. Visceral artery aneurysms (VAA) can be difficult to determine and most commonly occur in the splenic or hepatic artery. Gastroduodenal artery pseudoaneurysms (GDA) have been reported to be the most common VAA following pancreatic surgery. We aim to outline the successful management of a patient with a recurrent 5.5cm GDA pseudoaneurysm following previous embolisation 2 years prior. Methods The 59yr old patient had a history of alcohol related necrotic pancreatitis with pseudocyst formation requiring percutaneous drainage in 2019. This was complicated by pseudoaneurysm formation requiring embolisation of the inferior pancreatico-duodenal artery and GDA. In April 2021 they were readmitted with recurrent abdominal pain thought to be secondary to chronic pancreatitis and one episode of haematemesis. Results Endoscopy revealed inflammation of D1 with signs of recent mucosal bleeding with a recent abdominal ultrasound showing a 4.7x4.6cm apparent pseudocyst. A CT pancreas was performed to assess the pseudocyst however an incidental pseudoaneurysm at the pancreatic head with a sac measuring 5.5cm in diameter and contrast material measuring 3cm in diameter was present. Peripancreatic and retroperitoneal inflammation indicative of acute on chronic pancreatitis. The patient underwent embolisation of the recurrent GDA pseudoaneurysm successfully with no more filling of the previously seen pseudoaneurysm and was safely discharged. Conclusions Recurrent GDA pseudoaneurysms are a very rare complication of recurrent pancreatitis, however should be considered in patients presenting severe epigastric pain with a history of previous pseudoaneurysms.

Pancreatic pseudoaneurysm and its conundrum

Rupture of visceral artery pseudoaneurysm can lead to hypovolemic shock in a patient with pancreatitis. With the advent of minimally invasive treatment techniques most of these can be managed by minimally invasive route and have excellent prognosis when timely intervention is initiated. Herewith, we reported a case of ruptured pseudoaneurysm of superior pancreaticoduodenal artery in a patient with pancreatitis who presented with haematemesis. The patient was successfully managed with coil embolization. A brief case report with review of literature is presented here.

Ruptured Left Gastric Artery Aneurysm Associated with Fibromuscular Dysplasia

Background: Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease that commonly affects renal and carotid arteries but involvement of virtually any vascular territory has been observed. Research Design/ Study sample: This is a case report of a ruptured left gastric artery aneurysm as the first presentation of fibromuscular dysplasia. Data collection: After written consent from the patient, relevant clinical notes and imaging were retrospectively reviewed and critically analysed. Purpose: This case reiterates the importance of considering fibromuscular dysplasia as an uncommon cause of visceral artery aneurysms. In addition, this case shows that the impact of visceral artery vasospasm on endovascular access should not be underestimated and subsequent attempts can be successful after a period of resuscitation. Results: After initial difficulty in endovascular treatment due to visceral vasospasm, the case was successfully managed with with staged open ligation and endovascular embolization after a period of resuscitation. Conclusions: FMD is an important differential diagnosis to consider in cases of visceral aneurysms.

Splenic and hepatic artery aneurysm: a case report

Visceral artery aneurysms (VAA) have an incidence of 0.01-2% and are mainly diagnosed as an incidental finding in imaging studies done for other reasons. Their mortality when ruptured can be as high has 75%. We present a rare case of multiple visceral artery aneurysms that presented as dull abdominal pain and were managed with open surgery in accordance to specific treatment criteria.